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Melanie Cole (Host):  This is ChristianaCare’s Podcast series. I’m Melanie Cole. And today, we’re talking about home care versus institutional care for our loved ones. Our speaker in the podcast series represent the Swank Center for Memory Care and Geriatrics Delaware’s first and most comprehensive outpatient program dedicated to the assessment and assistance of older adults and their caregivers coping with dementia and other neurocognitive disorders. Joining me is Peachy Tabangin-Griffin. She’s a Senior Social Worker at the Swank Center for Memory Care and Geriatric Consultation at ChristianaCare. Peachy, I’m so glad to have you join us today. as we are discussing institutional care versus home care and whether to keep our loved ones at home; what are some of the most common health issues that seniors are confronted with?

Peachy Tabangin-Griffin, MSS, LCSW (Guest):  So, some of the common issues that bring up this question would be memory disorders, dementias, sometimes it’s related to a person’s physical abilities and functional abilities. So, strokes, falls, that might result in injuries, hip fractures, other fractures. Things like that.

Host:  Well one of the things that I find really important Peachy, and this is just recently happened to me, is the planning for this type of thing and not everybody thinks about whether they should have long term care insurance or whether they should have an advanced directive, living wills, what they want when they cannot be an independent living at home person. How important, tell us about planning and what they need to really think about.

Peachy:  I think planning is so important. And a lot of times, I find that family members and older adults are reluctant to think about what might happen in situations where they may need long term care or assistance in the home or other services in the community. A lot of times, we don’t want to think about the bad things or the emergency situation. But I think that planning is very helpful even in just knowing the resources that are in the community or to have an idea or an outline of what I would want care to look like in certain situations.

Host:  When is it that they should be doing this? Should the loved one being doing this with their family members? Should the family members start the process? When do you advice this starts?

Peachy:  I always tell patients and family members that I work with that a good time to start planning is now. Usually, it’s a good time when you are not in a stressful situation, when your health needs are relatively stable, you’re able to think clearly, make your wants and needs known in terms of future care planning. Many times it may be up to a family member or loved one to maybe get that conversation started and it’s definitely a process. It’s not something that maybe we’re going to sit down at dinner and knock out decisions in a couple of hours.

I really do believe it’s a process. It takes time to have these conversations to make thoughtful decisions, to research to options and to really do what’s best for our loved one, our family members all who are involved.

Host:  Well now comes the million dollar question, Peachy. How do you go about choosing between home care and an assisted living or a place like the Swank Center. What is it that we’re looking for in a center and what is it that we’re looking for in home care?

Peachy:  There are a few things that need to be considered when making the decision between having in home care versus a facility or institutional care. And one of those is going to be the care needs of our loved one. Are these care needs able to be met at home? Are the caregivers able to provide the care and attend to the needs of the loved one? Finances is another concern. Is care in a facility affordable? What are the other options? Is there long term care insurance or a policy available? Does the loved one qualify for state assistance such as Medicaid services? What are the other options that might work out?

And then in looking at facilities; I think again in terms of planning, knowing what’s available, knowing what the care needs are and trying to match those with either the caregiver in the home or the appropriate facility in the community.

Host:  What are you looking for in a facility? Because it’s easy to tour and you go on these tours and what is it that you want to be looking for? What do you want to concentrate and especially when you’re dealing with a loved one that has a neurocognitive disorder; what are the kinds of things that you should really pay attention to?

Peachy:  So, when you’re touring area facilities, you want to use all of your senses. So, you are going to be looking at the environment, you are going to be listening to what you hear, you are going to be using your nose and doing that smell test as well. So, you want to be observant to other residents or other people who live in the facility to see how they are cared for. You are going to be looking at interactions between staff and residents, looking for programming, also looking to make sure that the services and type of care needs that your loved one has are able to be met by the facility that you are looking at.

And so one example is in looking at for example a memory care assisted living; are the entrances secure, are there appropriate activities and programs for your loved one who might have memory concerns?

Host:  Well then tell us about the Swank Center for Memory Care and Geriatrics. Tell us about your team and what listeners can expect if they come there to visit.

Peachy:   Our office does memory assessments as well as geriatric assessments for older adults. Our team is an interdisciplinary team. So, we have geriatricians, we have a neurologist, a physician assistant, nurse practitioner in addition to social work support. And social work support provides support to not only our patients but also our family members and caregivers in providing information and resources about caregiving, communication, education and also talking about what’s available in our community.

Host:  Well thank you for that answer. So, before we wrap up, for caregivers and we discussed a little bit about planning; how can they approach the subject of home care and driving concerns and assisted living and memory care? What language can you give them advise about starting that conversation because sometimes, that’s the most challenging thing is just beginning that conversation.

Peachy:  That is correct. A lot of times, I think we are starting that conversation in the office. In terms of the approach, I’m often advising caregivers to think about the way we say things and how we are approaching our loved ones. I know a lot of times, it’s out of love and concern but it may not be received or accepted that way. So, again, a lot of encouragement, just kind of talking about what the concerns are and not necessarily always making it about the loved one. That it’s not because of something they did of because of something they are not able to do. And if they are able to be a part of the discussion and make the choices, allow them that. Allow them as much as they are able to be part of the decision making and a part of the process and conversation.

Host:  I feel that that is so important. Give us your best advice Peachy, on what you would like listeners to know, not only about the Swank Center for Memory Care and Geriatrics but about their loved ones when they start to notice a decline, whether it’s neurocognitive or physical, please tell them your best advice about planning and deciding between that home care and what things cost, convenience, care level, all of these things that they need to consider when they are looking at this.

Peachy:  So, I think coming to a place like the Swank Center for Memory Care and Geriatric Consultation would be very helpful in starting to get the diagnosis, starting to learn about treatment or care options, talking to social workers or other people in the community who are able to give information and resources. Getting caregiver support, I think that a lot of times family members think that they’re managing and doing okay in the home setting. I don’t think it’s a good idea to wait to get caregiver support until you’re to the point of caregiver stress and burnout where you can’t do it any longer. I think that caregivers would benefit by thinking about caregiver self-care, caregiver respite sooner rather than later and getting information about resources and care options so that when the time comes that a change in care may be needed; that you have some information and you are able to move forward.

Host:  Thank you so much Peachy for coming on today and helping us with something that so many families grapple with. It’s such important information. That concludes this episode of ChristianaCare’s Podcast Series. For an appointment at the Swank Center for Memory Care and Geriatrics, Delaware’s first and most comprehensive outpatient program dedicated to the assessment and assistance of older adults and their caregivers coping with dementia and other neurocognitive disorders, please call 302-320-2620 to schedule an evaluation. To learn more about programs and services please visit www.christianacare.org to get connected with one of our providers. Please also remember to subscribe, rate and review this podcast and all the other ChristianaCare podcasts. I’m Melanie Cole.